Giant coronary artery aneurysm arising from the sinus node artery with a fistula into the left atrium

Area of Science:

• Cardiology
• Vascular Surgery
• Radiology

Background:

• Giant sinus node artery aneurysms with left atrial fistula are exceedingly rare cardiovascular conditions.
• A 76-year-old female presented with an abnormal chest X-ray, prompting further investigation.

Purpose of the Study:

• To report a rare case of a giant sinus node artery aneurysm with a left atrial fistula.
• To describe the diagnostic imaging and successful surgical management of this anomaly.

Main Methods:

• Coronary computed tomography (CT) angiography identified a giant coronary aneurysm (70x50 mm) with feeding arteries from the sinus node and left circumflex arteries, and a fistula to the left atrium.
• Coronary angiography confirmed contrast drainage into the left atrium via the fistula.
• Surgical intervention involved ligation of feeding arteries, cardiopulmonary bypass, fistula closure with a patch, and resection of the aneurysmal wall.

Main Results:

• The fistula entry measured 2 cm and was successfully closed.
• Histopathological examination revealed atherosclerosis as the cause of the aneurysm.
• The patient experienced an uneventful postoperative recovery, with CT confirming complete aneurysm exclusion.

Conclusions:

• Surgical management is effective for giant sinus node artery aneurysms with left atrial fistulas.
• Atherosclerosis can be an underlying cause of these rare aneurysms.
• Multimodality imaging and surgical expertise are crucial for successful treatment.